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Gastric cancer, nutritional status, and outcome

Authors Liu X, Qiu H, Kong P, Zhou Z, Sun X

Received 14 January 2017

Accepted for publication 30 March 2017

Published 12 April 2017 Volume 2017:10 Pages 2107—2114

DOI https://doi.org/10.2147/OTT.S132432

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Ashok Kumar Pandurangan

Peer reviewer comments 3

Editor who approved publication: Dr Faris Farassati

Xuechao Liu,1,2,* Haibo Qiu,1,2,* Pengfei Kong,1,2,* Zhiwei Zhou,1,2 Xiaowei Sun1,2

1State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 2Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, People’s Republic of China

*These authors contributed equally to this work

Background: We aim to investigate the prognostic value of several nutrition-based indices, including the prognostic nutritional index (PNI), performance status, body mass index, serum albumin, and preoperative body weight loss in patients with gastric cancer (GC).
Materials and methods: We retrospectively analyzed the records of 1,330 consecutive patients with GC undergoing curative surgery between October 2000 and September 2012. The relationship between nutrition-based indices and overall survival (OS) was examined using Kaplan–Meier analysis and Cox regression model.
Results: Following multivariate analysis, the PNI and preoperative body weight loss were the only nutritional-based indices independently associated with OS (hazard ratio [HR]: 1.356, 95% confidence interval [CI]: 1.051–1.748, P=0.019; HR: 1.152, 95% CI: 1.014–1.310, P=0.030, retrospectively). In stage-stratified analysis, multivariate analysis revealed that preoperative body weight loss was identified as an independent prognostic factor only in patients with stage III GC (HR: 1.223, 95% CI: 1.065–1.405, P=0.004), while the prognostic significance of PNI was not significant (all P>0.05). In patients with stage III GC, preoperative body weight loss stratified 5-year OS from 41.1% to 26.5%. When stratified by adjuvant chemotherapy, the prognostic significance of preoperative body weight loss was maintained in patients treated with surgery plus adjuvant chemotherapy and in patients treated with surgery alone (P<0.001; P=0.003).
Conclusion: Preoperative body weight loss is an independent prognostic factor for OS in patients with GC, especially in stage III disease. Preoperative body weight loss appears to be a superior predictor of outcome compared with other established nutrition-based indices.

Keywords: nutritional status, preoperative body weight loss, prognosis, gastric cancer, adjuvant chemotherapy
 

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